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Abuse of smallest babies may have risen, study finds

A new look at child abuse reports suggests there may have been a small but worrying rise in injuries to babies over the past decade or so. While most research suggests child abuse is down overall, the report published on Monday in the journal Pediatrics shows infants are far from safe.

The study contradicts government data collected over the same time, and it shows that health officials need to take a better look at whether child abuse is getting better, worse or staying the same, experts said.

“I think it’s premature to make any conclusions about whether it is going up or down,” says Dr. James Anderst, chief of the section on child abuse and neglect at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who was not involved in the study. “Medical providers may be getting better at identifying abuse over time.”

Either way, it’s still happening and that’s a concern, says Dr. John Leventhal of Yale University, who led the study. “Maybe parents are doing better and hurting their children less in general, but there is a small group where there continue to be substantial injuries that end in hospitalization,” Leventhal said.

Leventhal and colleague Julie Gaither looked at statistics on children admitted to hospitals for serious injuries. Writing in the journal Pediatrics, they said they found a nearly 11 percent increase over 12 years in serious injuries to babies a year old and younger.

This is at the same time that two major national surveys of child abuse found decreases of between 55 percent and 23 percent in child abuse injuries overall, for all ages, between 1997 and 2009. It's important to point out that each study goes to different sources for data -- this week's study looks at hospital admissions, while the government studies examined reports of abuse filed to Child Protective Services and other agencies by doctors and other sources.

Child abuse is a serious problem in the United States. The Centers for Disease Control and Prevention says more than 740,000 children and youth are treated in hospital emergency departments for injuries resulting from violence every year.

“Child abuse, neglect or violence can actually affect the development of a child’s brain – impacting the child now and for years to come. Our Adverse Childhood Experiences (ACE) studyshows a connection between child maltreatment and some of the nation’s worst health problems, including depression and heart disease,” CDC child abuse expert Linda Degutis says in a blog on the agency’s website.

CDC declined comment on Monday’s study in Pediatrics.

“I would say that the experts in this area are still trying to make sense of the various trends in physical abuse and explain why there are divergences,” said David Finkelhor of the University of New Hampshire, who led one of the studies showing a decrease in child abuse injuries between 1997 and 2009. “This new report is helpful but does not resolve any of the outstanding questions.”

Leventhal said it’s important to get better data, but says it’s difficult. “It is probably harder to substantiate a physical abuse case now than it was 15-20 years ago,” he says -- mostly because agencies have tightened the rules for classifying cases as child abuse. “My colleagues in child protective services say it is much harder.” Many, he says, classify abuse cases as neglect instead. But it would be important to get data to back this up.

Anderst and Leventhal both said education is an important way to help prevent child abuse. “Over 50 percent of the kids on my study were infants. Thirty to 40 percent of those infants had abusive head trauma, often known as shaken baby syndrome,” Leventhal said. That suggests parents are caretakers who are frustrated and don’t know how to cope with a wailing baby, he said.

“I think, regardless of the cause, the message is too many children, particularly very young children are getting hurt,” he said. “And pediatricians and others who look after children need to craft clear messages so that children are not hurt by abuse.

Yale’s hospital has an approach called “Take Five.” “If you feel like you are going to lose it, put the baby in a safe place, namely a crib, step back and take five,” Leventhal says. Some states are also giving new parents information about not shaking their babies – even seemingly gentle shakes can cause traumatic brain injury. “There are now systematic efforts funded in part by the CDC to see whether education about crying infants, about stepping away, about not shaking a baby, change the likelihood that children end up in the hospital with those injuries,” Leventhal added.

Sometimes people were themselves beaten as children, and pass this behavior along, Anderst said. “Some people are just ill-prepared to be parents and don’t know how to handle children. Some people come from violent backgrounds and that is how they handle their problems.”

So how to change this behavior? “It’s the same way we get people to quit smoking. It is the same way we get people to wear seat belts. It is a combination of laws and enforcement of those laws and also supporting people so they can be better parents,” Anderst said.

He said government officials should think about those consequences when they cut programs to save money in state budgets.

Sometimes it's not the parents who are doing the harm but someone outside the family.

Dr. Suzanne Starling, a pediatrician at Eastern Virginia Medical School, has made intensive studies of who’s hurting kids, and found a consistent pattern: men are far more likely to hit, shake or batter young children. One study she published in the Southern Medical Journal found fathers committed 45 percent of attacks, and boyfriends of the mothers another 25 percent.

“Parents need to believe that the people close to them might have the potential to lose it with a frustrating circumstance such as a crying baby,” Leventhal advised. “They need to say each of the people who looks after their child, ‘my baby cries sometimes and it gets frustrating. If you feel that way, call me. I will come home from work. But don’t hurt my baby’.”